4 - Epidemiology, Indices, and Statistics

Question 1

Describe the gingival index, plaque index, and retention index

Who are they by?

Answer 1

Gingival index
0 - No bleeding 
1 - Color change
2 - BOP
3 - Spontaneous BOP

Plaque index
0 - no plaque
1 - plaque w/ probe sweep
2 - visible plaque
3 - gross plaque

Retention index
0 - no roughness
1 - supragingival roughness/calculus
2 - subgingival
3 - gross roughness

LOE

Question 2

What are the Ramfjord teeth?

Answer 2

3,9,12,19,25,28

Question 3

What is another plaque index?

Answer 3

Turesky-Gilman-Glickman Modification of Quigley Hein

0 - no plaque
1 - flecks at margin
2 - <1mm band
3 - >1mm band, <1/3
4 - 1/3-2/3 band
5 - >2/3 band

Question 4

What is an example of a bleeding index?

Answer 4

Interdental bleeding index by Caton

Stim-U-Dent from facial, depress papilla 1-2mm 4X and assess bleeding within 15 seconds

Question 5

What was the first disease index to include CAL?

Answer 5

Periodontal Disease Index by Ramfjord

Ramfjord teeth on B + M
0 - no inflammation
1 - mild spots of inflammation
2-  circumferential inflammation
3 - severe gingivitis
4 - CAL <3mm
5 - CAL 4-6mm
6 - CAL >6mm

Question 6

What are two indices of treatment needs?

Answer 6

CPI - Community Periodontal Index
-WHO probe, highest score per sextant, 1M/2M/8/24

0 - healthy
1 - BOP
3 - Calculus + BOP
4 - PD 4-5mm
5 - PD 6mm+

PSR
0 - healthy
1 - BOP
2 - BOP + calculus
3 - PD 3.5-5.5mm
4 - PD >6mm

Question 7

What is the effect of partial recording protocols? What is most effective

Answer 7

Susin - underestimate CAL prevalence. Full mouth MB/B/Dl w/ smallest bias

Question 8

Is the NHANES accurate with partial recording protocols?

Answer 8

Eke

NO - underestimation. 9% was what they thought when it was actually 22%

Question 9

What is the prevalence of ChP in the US? What populations are most affected?

Answer 9

NHANES 2009-2014 w/ FMPE

42.2%. Severe ChP 7.8%

Older, Mexican, smokers, diabetics, under FPL, lack of dental care

Question 10

What states are most/least affected?

Answer 10

Prevalence
NM - highest
Utah - lowest

Severity
Louisiana - Highest
New Hampshire - Lowest

Question 11

Are caries and ChP related?

Answer 11

Mattila - NHANES

ChP w/ caries 33%
Healthy w/ caries 23%

Caries w/ severe ChP 31%
No caries w/ severe ChP 16%

Tend to accumulate in the same subjects

Question 12

What should I expect in a population of treated and untreated periodontitis?

Answer 12

Loe 1978

• According to the Loe study of Norwegians and Sri Lankans, for a population with access to dental care a rate of 0.08-0.10mm loss of attachment per year and localized to the buccal can be expected. For a population with no dental care, a rate of 0.3mm/year, often found interproximally can be expected.
• Disease progression did not significantly increase with age. This study demonstrates the efficacy of oral hygiene at minimizing attachment loss

Question 13

If I have prior CAL, will I automatically have future CAL?

Answer 13

Lindhe - NO

In a longitudinal study of Swedish and American patients, the progression of disease was infrequent and sites with prior CAL should not be regarded as a prognostic factor for further disease progression

Question 14

Does everyone have CAL at the same rate?

Answer 14

Loe

No, in Sri Lankans over 15 years there were 3 groups

Rapid - 8%
Moderate - 81%
No - 11%

Question 15

What are long term consequences for lack of dental treatment?

Answer 15

Ramseier 2017

After a 40 year f/u with the Sri Lankans, the average tooth loss/subject was 13.1

Smoking, calculus, and plaque are associated with disease initiation and progression

Question 16

What are some predictive factors for ChP?

Answer 16

Schatzle - In Norwegians, smokers 2X and calculus 5X are associated with disease progression

Paulander - In 50 year old patients, the # of remaining teeth, existing RBL, and education levels had a significant influence on the progression of ChP

EKe - NHANES 65+, males, AA, and smokers

Question 17

What is the cause of early LOA?

Answer 17

Heitz-Mayfield

Norwegians, recession is the primary cause of early loss of attachment. Especially on the buccal of posterior teeth

IP pocketing >3mm is more common for age >50 years old

Question 18

How common is recession?

Answer 18

Loe

Norwegians - >60% of 20 year olds on buccal surface
Sri Lankan - 100% 40 year old. 70% buccal, 50% lingual, and 40% IP

Albander - NHANES. 58% w/ >1mm of recession and 22% teeth/person with 1mm of recession

MAX 1M and mandibular central incisors

Question 19

How common is BOP? Calculus?

Answer 19

Albander NHANES

BOP 50%, increase in extent w/ increasing age

Calculus 92%. 50% of teeth/person

Question 20

What is a risk factor?

Answer 20

A characteristic that increases the probability that an event will occur

Question 21

What is a prognostic factor

Answer 21

A measurable characteristic at the time of diagnosis that gives info on the likely clinical outcome

Question 22

What is a risk ratio

Answer 22

The probability that an individual of the exposed group will develop the disease relative to the probability that an individual of the unexposed group will develop disease

Question 23

What is an odds ratio

Answer 23

The odds that an outcome will occur with the exposure compared to the probability that the outcome will occur without exposure